Dataset Information

The financing need for expanded maternity protection in Indonesia.

ABSTRACT:

Background

Almost half of all Indonesian children under 6 months of age were not exclusive breastfed in 2017. Optimizing maternity protection programs may result in increased breastfeeding rates. This study aims to: estimate the potential cost implications of optimizing the current paid maternity protection program, estimate budgets needed to increase coverage of lactation rooms in mid and large firms, and explore challenges in its implementation in Indonesia.

Methods

The potential cost implication of the current and increased maternity leave length (three and 6 months) as well as the potential budget impact to the government were estimated for 2020 to 2030. The cost of setting up lactation rooms in formal sector companies was estimated using the Alive & Thrive standards. Interviews were conducted in five different provinces to 29 respondents in 2016 to identify current and potential challenges in implementing both existing and improved maternity protection policies.

Results

The costs of expanding paid maternity leave from three to 6 months and incorporating standardized lactation rooms in 80% of medium and large size firms in Indonesia was estimated at US$1.0 billion (US$616.4/mother per year) from 2020 to 2030, covering roughly 1.7 million females. The cost of setting up a basic lactation room in 80% of medium and large companies may reach US$18.1 million over 10 years. The three main barriers to increasing breastfeeding rates were: breastmilk substitutes marketing practices, the lack of lactation rooms in workplaces, and local customs that may hamper breastfeeding according to recommendations.

Conclusions

The cost of expanding paid maternity leave is lower than the potential cost savings of US$ 1.5 billion from decreased child mortality and morbidity, maternal cancer rates and cognitive loss. Sharing the cost of paid maternity leave between government and the private sector may provide a feasible economic solution. The main barriers to increasing breastfeeding need to be overcome to reap the benefits of recommended breastfeeding practices.

SUBMITTER: Siregar AYM

PROVIDER: S-EPMC6593591 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The financing need for expanded maternity protection in Indonesia.

Siregar Adiatma Y M AYM Pitriyan Pipit P Walters Dylan D Brown Matthew M Phan Linh T H LTH Mathisen Roger R

International breastfeeding journal 20190625

<h4>Background</h4>Almost half of all Indonesian children under 6 months of age were not exclusive breastfed in 2017. Optimizing maternity protection programs may result in increased breastfeeding rates. This study aims to: estimate the potential cost implications of optimizing the current paid maternity protection program, estimate budgets needed to increase coverage of lactation rooms in mid and large firms, and explore challenges in its implementation in Indonesia.<h4>Methods</h4>The potentia ...[more]

PMID: 31289458

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Project description:BackgroundFor Malaysia, a nation highly dependent on migrant labour, the large non-citizen workforce presents a unique health system challenge. Although documented migrant workers are covered by mandatory healthcare insurance (SPIKPA), financial constraints remain a major barrier for non-citizen healthcare access. Malaysia recently extended protection for migrant workers under the national social security scheme (SOCSO), previously exclusive to citizens. This study aims to evaluate healthcare financing and social security policies for migrant workers to identify policy gaps and opportunities for intervention.MethodsA total of 37 in-depth interviews were conducted of 44 stakeholders from July 2018 to July 2019. A mixed-methods analysis combining major themes from qualitative interviews with policy document reviews was conducted. Descriptive analysis of publicly available secondary data, namely revenues collected at government healthcare facilities, was conducted to contextualise the policy review and qualitative findings.ResultsWe found that migrant workers and employers were unaware of SPIKPA enrolment and entitlements. Higher fees for non-citizens result in delayed care-seeking. While the Malaysian government nearly doubled non-citizen healthcare fees revenues from RM 104 to 182 million (USD 26 to 45 million) between 2014 to 2018, outstanding revenues tripled from RM 16 to 50 million (USD 4 to 12 million) in the same period. SPIKPA coverage is likely inadequate in providing financial risk protection to migrant workers, especially with increased non-citizens fees at public hospitals. Undocumented workers and other migrant populations excluded from SPIKPA contribution to unpaid fees revenues are unknown. Problems described with the previous Foreign Workers Compensation Scheme (FWCS), could be partially addressed by SOCSO, in theory. Nevertheless, questions remain on the feasibility of implementing elements of SOCSO, such as recurring payments to workers and next-of-kin overseas.ConclusionMalaysia is moving towards migrant inclusion with the provision of SOCSO for documented migrant workers, but more needs to be done. Here we suggest the expansion of the SPIKPA insurance scheme to include all migrant populations, while broadening its scope towards more comprehensive coverage, including essential primary care.

Project description:BackgroundDemand-side financing, where funds for specific services are channelled through, or to, prospective users, is now employed in health and education sectors in many low- and middle-income countries. This systematic review aimed to critically examine the evidence on application of this approach to promote maternal health in these settings. Five modes were considered: unconditional cash transfers, conditional cash transfers, short-term payments to offset costs of accessing maternity services, vouchers for maternity services, and vouchers for merit goods. We sought to assess the effects of these interventions on utilisation of maternity services and on maternal health outcomes and infant health, the situation of underprivileged women and the healthcare system.MethodsThe protocol aimed for collection and synthesis of a broad range of evidence from quantitative, qualitative and economic studies. Nineteen health and social policy databases, seven unpublished research databases and 27 websites were searched; with additional searches of Indian journals and websites. Studies were included if they examined demand-side financing interventions to increase consumption of services or goods intended to impact on maternal health, and met relevant quality criteria. Quality assessment, data extraction and analysis used Joanna Briggs Institute standardised tools and software. Outcomes of interest included maternal and infant mortality and morbidity, service utilisation, factors required for successful implementation, recipient and provider experiences, ethical issues, and cost-effectiveness. Findings on Effectiveness, Feasibility, Appropriateness and Meaningfulness were presented by narrative synthesis.ResultsThirty-three quantitative studies, 46 qualitative studies, and four economic studies from 17 countries met the inclusion criteria. Evidence on unconditional cash transfers was scanty. Other demand-side financing modes were found to increase utilisation of maternal healthcare in the index pregnancy or uptake of related merit goods. Evidence of effects on maternal and infant mortality and morbidity outcomes was insufficient. Important implementation aspects include targeting and eligibility criteria, monitoring, respectful treatment of beneficiaries, suitable incentives for providers, quality of care and affordable referral systems.ConclusionsDemand-side financing schemes can increase utilisation of maternity services, but attention must be paid to supply-side conditions, the fine-grain of implementation and sustainability. Comparative studies and research on health impact and cost-effectiveness are required.

Project description:BackgroundMany women work in positions of non-standard employment, with limited legal and social protection. Access to comprehensive maternity protection for all working women could ensure that all women and children can access health and social protection. This study aimed to describe the maternity protection benefits available to women in positions of non-standard employment in South Africa, using domestic workers as a case study.MethodsA qualitative descriptive study design was used. National policy documents containing provisions on maternity protection were identified and analysed. Interviews were conducted with purposively selected key informants. Data extracted from published policy documents and information obtained from interviews were triangulated. A thematic analysis approach was used for evaluation of policy content and analysis of the interviews.ResultsTwenty-nine policy and legislative documents were identified that contain provisions on maternity protection relevant to non-standard workers. These documents together with three key informant interviews and two media releases are used to describe availability and accessibility of maternity protection benefits for non-standard workers in South Africa, using domestic workers as a case study. Maternity protection is available in South Africa for some non-standard workers. However, the components of maternity protection are dispersed through many policy documents and there is weak alignment within government on maternity protection. Implementation, monitoring, and enforcement of existing maternity protection policy is inadequate. It is difficult for non-standard workers to access maternity protection benefits, particularly cash payments. Some non-standard workers have unique challenges in accessing maternity protection, for example domestic workers whose place of work is a private household and therefore difficult to monitor.ConclusionThe heterogeneity of non-standard employment makes it challenging for many women to access maternity protection. There are policy amendments that could be made and improvements to policy implementation that would enhance non-standard workers' access to maternity protection. Potential long-term benefits to women and children's health and development could come from making comprehensive maternity protection available and accessible to all women.

Dataset Information

The financing need for expanded maternity protection in Indonesia.

Background

Methods

Results

Conclusions

Publications

The financing need for expanded maternity protection in Indonesia.

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